Department of Paediatrics and Child Health, University of Otago Wellington, P.O. Box 7343, Wellington South, Wellington, New Zealand.
Department of Paediatrics and Child Health, University of Otago Wellington, P.O. Box 7343, Wellington South, Wellington, New Zealand.
Epilepsy Res. 2014 Aug;108(6):1087-94. doi: 10.1016/j.eplepsyres.2014.04.006. Epub 2014 May 14.
To investigate biochemical cardiovascular risk factors and vascular endothelial function and structure in children with epilepsy on antiepileptic drugs (AEDs), particularly sodium valproate (VPA) and carbamazepine (CBZ).
Individuals with epilepsy have increased risk factors for vascular disease, particularly lipid abnormalities and elevated total plasma homocyst(e)ine (tHcy). AED induced B-vitamin deficiencies have been suggested to contribute to this risk. Vitamin B supplementation has consequently been recommended for children on AEDs. Early vascular endothelial dysfunction and atherosclerosis are detectable by measuring flow-mediated dilation (FMD) and intima-media thickness (IMT).
Thirty children with epilepsy on AEDs (13.3±2.3 years, 14 male) and 30 controls (13.9±2.9 years, 14 male) were recruited. Fasting tHcy, folate, pyridoxal-5-phosphate (PLP), vitamin B12, glucose and lipids were measured. Vascular function and structure were assessed using FMD (brachial artery) and IMT (carotid/aortic arteries).
No differences were found between children with epilepsy and controls for tHcy, folate, PLP, lipids, FMD, carotid or aortic IMT. Vitamin B12 levels were elevated and glucose reduced in children treated with VPA. Elevated total cholesterol, cholesterol/HDL ratio and triglycerides occurred in children treated with CBZ. Aortic IMT correlated with weight (r=0.75, p<0.001), BMI (r=0.54, p=0.01), and HDL cholesterol (r=-0.58, p=0.006).
We found no early changes in vascular function or structure in children on valproate or carbamazepine. We were also unable to confirm previous reports of tHcy abnormalities in this group. This may be due to higher B-vitamin intake, which compensates for loss of vitamins induced by this AED therapy. Vitamin supplementation in children with epilepsy on valproate and carbamazepine is not required in populations with adequate dietary intake of B vitamins.
研究抗癫痫药物（AED）特别是丙戊酸钠（VPA）和卡马西平（CBZ）治疗的癫痫患儿的生化心血管危险因素和血管内皮功能及结构。
癫痫患者发生血管疾病的危险因素增加，尤其是血脂异常和总血浆同型半胱氨酸（tHcy）升高。有研究认为，AED 诱导的 B 族维生素缺乏与这种风险有关。因此，建议癫痫患儿服用维生素 B 补充剂。通过测量血流介导的舒张功能（FMD）和内膜中层厚度（IMT）可以检测到早期的血管内皮功能障碍和动脉粥样硬化。
共纳入 30 名服用 AED 的癫痫患儿（13.3±2.3 岁，男 14 例）和 30 名对照（13.9±2.9 岁，男 14 例）。测量空腹 tHcy、叶酸、吡哆醛-5-磷酸（PLP）、维生素 B12、血糖和血脂。采用 FMD（肱动脉）和 IMT（颈总动脉/主动脉）评估血管功能和结构。
癫痫患儿与对照组的 tHcy、叶酸、PLP、血脂、FMD、颈动脉或主动脉 IMT 无差异。丙戊酸钠治疗组的维生素 B12 水平升高，血糖降低。卡马西平治疗组的总胆固醇、胆固醇/高密度脂蛋白比值和甘油三酯升高。主动脉 IMT 与体重（r=0.75，p<0.001）、BMI（r=0.54，p=0.01）和高密度脂蛋白胆固醇（r=-0.58，p=0.006）相关。
我们未发现服用丙戊酸钠或卡马西平的患儿血管功能或结构有早期变化。我们也无法证实该组 tHcy 异常的先前报道。这可能是由于更高的 B 族维生素摄入量，这种摄入量可以弥补 AED 治疗引起的维生素丢失。在 B 族维生素摄入充足的人群中，服用丙戊酸钠和卡马西平的癫痫患儿不需要补充维生素。
